Association of Cognition, Frailty, & Peak Airflow With Dysphagia in Older Adults: A National Study

To evaluate the impact of cognition, frailty, and peak airflow on dysphagia among older adults.

Our study utilized Round 12 (2023) of the National Health and Aging Trends Study (NHATS), a nationally representative database of Medicare beneficiaries. Dysphagia was defined as a person's self-reported, subjective experience of swallowing difficulty; frailty was assessed with the physical frailty phenotype; and cognition was measured across memory, orientation, and executive function. Peak airflow was categorized as low if the z-score for observed peak expiratory flow (PEF), based on reference equations for age, gender, and height, was ≤ 2. Multivariate logistic regression models examined associations between dysphagia and cognition, frailty, and peak airflow, controlling for demographic confounders such as age, gender, and race/ethnicity.

This study included 5899 older adults (65+) of whom 687 reported dysphagia (median age, 80 years; 62.2% female). Frailty was significantly associated with dysphagia, with frail (adjusted odds ratio [aOR], 7.57; 95% CI 5.10-11.7; p ≤ 0.001) and pre-frail (aOR, 3.45; 95% CI 2.37-5.22; p ≤ 0.001) adults exhibiting significantly higher odds than robust individuals. Low peak airflow was significantly associated with dysphagia (aOR, 1.73; 95% CI 1.38-2.16; p ≤ 0.001), whereas dementia showed no significant association compared to normal cognition (aOR, 1.35; p = 0.13).

Frailty and low peak airflow were strongly associated with dysphagia among older adults in Round 12 of NHATS, and their presence may warrant swallowing assessment. This contrasts with dementia, suggesting objective findings of swallowing dysfunction may not always align with patients' experience in this group.

Level 4.